HomeMy WebLinkAbout612 N BRIARWOOD RD - APPLICATIONS - 7/12/2018Citvof ` Planning, Development, & Transportation Services
F
�... &t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ElElectrical Alteration (not se��rvic��e change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement b� Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 9)� -U0SS I LP Date _ 7I�Z�/o
For office use only
joci wre Address (required) Value of Construction (labor, materials, profit )
1 ��2
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Property Owner Name Address City/State Zip Phone
Appli t Name Address City/fate Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
saiesraxnumber isrequiredbyall contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coTx ercial project? esidential ❑ Commercial
If
residential, is it: Oningle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Rar El Church ❑ Hotel/Motel ❑ Medical office El Office ❑ Retail
❑ Restaurant ❑ Other (explai \v
�
Is this building 50 years of age or more? ❑ Yes o Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is com ete aA correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
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Print Name: l.L Signature � Date
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Revision date 216IM17